Provider Demographics
NPI:1750476834
Name:MALIK, AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:MALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 CHURCH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3476
Mailing Address - Country:US
Mailing Address - Phone:606-432-4104
Mailing Address - Fax:606-432-6817
Practice Address - Street 1:255 CHURCH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3476
Practice Address - Country:US
Practice Address - Phone:606-432-4104
Practice Address - Fax:606-432-6817
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20701207RC0000X, 207UN0901X, 207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64207012Medicaid
WV18036593000Medicaid
KY7799Medicare PIN
KY64207012Medicaid